Transcript Current Status of BTS in India

Access to medicines in the WHO European region
Supporting countries to achieve:

Equitable access for patients to effective, safe and good quality
medicines

Enhancing appropriate use of medicines for better health outcomes

Ensuring value for money

Balance with industrial policy objectives
Underpinning values : equity, solidarity, access, participation
Tailoring support to countries needs

Less-regulated markets, mostly out-of-pocket
payments, problems with access (NIS)

Well regulated markets, substantial public funding,
access and affordability problems (CCEE)

Tightly-regulated markets, largely public funding,
cost containment (EU)
Kyrgyzstan – improved access to essential
medicines through system of medical insurance
Benefits of pooled procurement + ABC/VEN analysis in System of medical Insurance (All Regions)
% of total value
Pooled procurement + ABC/VEN
25.0%
21,9%
20.0%
19,1%
16,2%
14,3%
15.0%
Pooled procurement
10.0%
6,3%
5,2%
5.0%
3,3%
0.0%
Bishkek
Chui
Osh
Issik-Kul
Djalal Abad
Narin
Talas
Kyrgyzstan – system of medical insurance
Increased prescribing of generic medicines
% of total prescriptions
95,8%
100
90
80
70
60
50
40
59,8%
40,2%
30
20
10
4,2%
0
August 2000
Generic prescribing
April 2002
Brand name prescribing
Russian Federation – improving access to quality TB drugs
 No domestic TB drug manufacturers met
TB morbidity growth in Russia (per 10 000 population)
Health for All database
international quality standards
100
90
 2 rounds of joint GMP inspections by
80
WHO/EURO and Ministries of Health and
70
Ruissia
Trend
60
Industry, supported by WB and USAID
 WHO inspections confirmed compliance
50
40
to GMP
30
 3 Russian manufacturers can supply
20
1985
90
95
Years
2000
Russian population with quality TB drugs
People can get access to adequate treatment
Georgia – improving access to essential medicines
through WHO pilot reimbursement scheme (with
support from UK and Tbilisi Municipality)
Drug Polis reimbursement 50%
90%
Patient payment
50%
0 Lari
100 Lari
Expenditure on prescription
medicines per year
PLUS:
20% discount on doctor’s fee in polyclinic
more
HIV infections newly diagnosed:
cases reported in 2002 per million population WHO
EURO Region
HIV cases per million
25
200 +
100 - 199
33
94
74*
23
74
105
256
NA
< 20
351
661
227
108
49
101
20 - 99
25
45
Not available
43
91
15
32
5
2
119 8
2 6
37
2
38
49
180
38
15
18
6
4
0
11 13
3
31
53
Data reported by 31 December 2002
* Netherlands: new system, data for 1st 6 months of 2002 only; include many cases diagnosed in previous years
Access to HAART
(Highly active anti-retroviral therapy)
RUS
EST
LAT
LIT
BEL
UKR
KAZ
MOL
ROM
ALB
GEO
BUL
TUR
BIH, FYM, YUG
No access to HAART
Individuals on HAART
Poor access ( <10%)
Partial access (10-70%)
Good access (over 70%)
ARM
AZE
UZB
TKM
KYZ
TJK
Central European countries

Broad transition to compulsory health insurance schemes

Implementation of medicines benefit package based on
essential drugs concept : positive-reimbursement list, reference
pricing, cost-effectiveness evaluations, safeguarding access to
vulnerable groups : Romania, Bulgaria, Slovak Republic,
Bosnia-Herzegovina, …

A common guideline for cost-effectiveness evaluation of
medicines for reimbursement in the Baltic countries
European Union enlargement
Rapidly changing drugs markets
Czech Republic*, 1990 and 2000
100%
19,7
90%
80%
15,5
70%
8,5
44,6
60%
50%
48,6
40%
39,8
30%
20%
16,2
10%
0%
1990
Unbranded
7,1
2000
Other brands
Origin/licensed
status n/a
*2000 Population: 10.3 million
Source: IMS Health, customised study. Data from 52 countries/areas
2 PAR Seminar October 2002
WHO - EDM
Challenges
“Squaring the circle” between rising expectations,
quality treatment, limited public funding and
achieving equitable access:
 be selective – need and efficiency – regarding which
medicines reimbursed/provided
 enhance use of generics
 strengthen appropriate prescribing
 increase efficiency and negotiating capacity of
buyers, while protecting patients
 shift to reference-pricing schemes